Provider Demographics
NPI:1124145669
Name:CHOCK, KYLE SIU QUON (DMD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:SIU QUON
Last Name:CHOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ULULANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2629
Mailing Address - Country:US
Mailing Address - Phone:808-961-2878
Mailing Address - Fax:808-933-1651
Practice Address - Street 1:212 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2629
Practice Address - Country:US
Practice Address - Phone:808-961-2878
Practice Address - Fax:808-933-1651
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice